Abstract Background Facial paralysis is a debilitating condition associated with significant functional, aesthetic, and psychosocial consequences. When spontaneous recovery fails, surgical facial reanimation becomes necessary. Hypoglossal–facial anastomosis (HFA) is a well-established reanimation technique; however, successful outcomes after prolonged denervation have rarely been reported. Case presentation We report the case of a 25-year-old woman with complete left-sided facial paralysis persisting for seven years following vestibular schwannoma resection via a retrosigmoid approach. Owing to severe functional impairment and psychosocial distress, delayed facial reanimation was considered. Preoperative electromyography was consistent with preserved facial muscle viability and supporting the indication for surgical reinnervation. A latero-terminal (side-to-end) hypoglossal–facial anastomosis was performed. At one-year follow-up, the patient demonstrated marked improvement in facial symmetry and voluntary facial movement, corresponding to House–Brackmann grade III, with minimal hypoglossal morbidity. Conclusion This case demonstrates that clinically meaningful facial reanimation may be achieved even after exceptionally prolonged denervation. Delayed latero-terminal hypoglossal–facial anastomosis represents a viable therapeutic option in carefully selected patients when facial nerve continuity is preserved, preoperative electromyography supports residual muscle viability, and strong patient motivation.
Yahia et al. (Mon,) studied this question.